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M A R C H 2 0 1 4 | O U T P AT I E N T S U R G E R Y M A G A Z I N E O N L I N E
S P I N E
Admitting patients unnecessarily after spine cases to meet Medicare's
demands results in higher-costing procedures with worse clinical outcomes,
which is exactly what Medicare punishes surgical facilities for. Elderly
patients, who make up about 30% of my caseload and are often on
Medicare, are at the highest risk of developing post-op DVT and pneumonia.
Does it make sense that they're the ones we have to operate on as inpa-
tients? It's a vicious cycle.
Because of Medicare, it's become increasingly difficult to negotiate with
third-party payors that are used to paying for inpatient spine surgery, even
though we're bringing them significant cost-savings and lower complica-
tions rates in outpatient settings.
In fact, a local hospital is the majority owner of one of my joint-venture
surgery centers. Even though the hospital already has established con-
tracts with carriers, we still can't get contracts to do cases. We've found
that most payors negotiate ridiculously low rates that wouldn't sustain
most surgery centers, so patients and doctors are left without the benefits
of improved outcomes and substantially less use of healthcare's limited
resources.
Spine's outpatient migration continues, but it's a very, very slow process
that's failing to capitalize on the specialty's true potential.
— Alan Villavicencio, MD
spine cases and critical to surgical success. Providing surgeons and
assistants with matching views of the action is key to maintaining
flawless communication at the table and improved case efficiencies
and outcomes. The microscope should be well balanced and
ergonomically comfortable. If it's not, your surgeons deserve a new
model.
• 3D image guidance
can be like having a CT scanner in the OR. Not
only can you navigate off the images for more technically accurate
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